An inherent bias in healthcare means women have poorer health outcomes. A government strategy aims to change that, and pharmacists have a part to play in levelling up healthcare for the sexes, writes Steve Titmarsh… 

The government’s first Women’s Health Strategy for England, published in August 2022, sets out a 10-year strategy of how it plans to right the wrongs created by failures in the health system. These failures contribute to the fact that even though women in the UK live, on average, longer than men they spend more of their lives in ill health and disability compared with men.¹

The Strategy is informed by more than 110,000 responses to a call for evidence, of which 97,307 were from individuals living in England. The ambition, as the document puts it, is that within 10 years the Strategy will have ‘boosted health outcomes for all women and girls, and radically improved the way in which the health and care system engages and listens to all women and girls’.

It consists of a six-point plan:

1. Ensuring women’s voices are heard – tackling taboos and stigmas, ensuring women are listened to by healthcare professionals, and increasing representation of women at all levels of the health and care system.
2. Improving access to services – ensuring women can access services that meet their reproductive health needs across their lives, and prioritising services for women’s conditions such as endometriosis. Ensuring conditions that affect both men and women, such as autism or dementia, consider women’s needs by default and being clear on how conditions affect men and women differently.
3. Addressing disparities in outcomes among women – ensuring that a woman’s age, ethnicity, sexuality, disability, or where she is from does not impact upon her ability to access services, or the treatment she receives.
4. Better information and education – enabling women and wider society to easily equip themselves with accurate information about women’s health, and healthcare professionals to have the initial and ongoing training they need to treat their patients knowledgably and empathetically.
5. Greater understanding of how women’s health affects their experience in the workplace – normalising conversations on taboo topics such as periods and the menopause to ensure women can remain productive and be supported in the workplace, and highlighting the many examples of good practice by employers.
6. Supporting more research, improving the evidence base and spearheading the drive for better data– addressing the lack of research into women’s health conditions, improving the representation of women of all demographics in research, and plugging the data gap and ensuring existing data is broken down by sex.

Seven priority areas have been identified, which include:

• Menstrual health and gynaecological conditions
• Fertility, pregnancy, pregnancy loss and post-natal support
• Menopause
• Mental health and wellbeing
• Cancers
• Health impacts of violence against women and girls
• Healthy ageing and long-term conditions

The Strategy takes a ‘life course’ approach, focussing on understanding the changing needs of girls and women throughout their lives, rather than a disease-orientated approach where each condition is managed as it arises. So the aim is to ‘identify critical stages, transitions and settings where there are opportunities to promote good health, to prevent negative health outcomes , or to restore health and wellbeing’.

Evidence from the public showed that 84 per cent of women said they had not been listened to by healthcare professionals. Another common issue is access to high quality information. Almost three-quarters (74 per cent) of those providing evidence said that family or friends were the main source of health information, followed by Google (71 per cent), other online search engines or blogs (69 per cent), GPs or healthcare professionals (59 per cent) and the NHS (54 per cent). People said they wanted more trusted and easier-to-understand information.

In terms of access to services it has been acknowledged that women’s health hubs or centres providing a ‘one-stop’ service can deliver healthcare for women conveniently and cost effectively. The Strategy supports the expansion of these. Providing access to oral contraception through community pharmacies is one example of helping improve access for women.

Workplace issues

In their evidence submission the Pharmacists’ Defence Association (PDA) and the National Association of Women Pharmacists (NAWP) say: “There are several ways in which the workplace could become more responsive to women’s health concerns, including addressing the under-representation of women in leadership positions, and involving women more in decision making and policy development.

“Company sickness policies need to be appropriately supportive and effective, and the Women’s Health Strategy should address how employers can meet their business or operational needs while addressing their duty of care in relation to their workforce and maximising health and wellbeing in the workplace.”²

The Royal Pharmaceutical Society says: “Conversations around women’s health should become normal, with a similar emphasis as wellbeing conversations. As healthcare professionals we have a responsibility to educate ourselves, to support each other and talk more openly to staff and patients on women’s health issues.”³

A role for pharmacists

The Strategy acknowledges that “community pharmacists and their teams are uniquely placed to provide support and advice on medicines as well as wider health advice and support to women at all stages of their lives”. The plan is to look at ways that community pharmacies can offer a wider range of services.

The General Pharmaceutical Council has highlighted the key role pharmacists play in safely dispensing sodium valproate, for example. In addition, community pharmacists can offer women additional support with their epilepsy medication through the New Medicine Service to provide specific advice when they start a new medicine, which includes responding to concerns about women’s wider health needs.⁴

The Company Chemists’ Association (CCA) notes that pharmacies already play a key role in providing health information and education to women and they are particularly well-placed to reach under-represented groups.

Pharmacies already take part in NHS campaigns but the CCA adds: “There are opportunities to make greater use of community pharmacies’ unique role as health and wellbeing hubs at the heart of communities, for example by providing more targeted interventions and campaigns to meet the needs of local populations.”⁵

The PDA and NAWP say: “Pharmacists have a unique opportunity to open conversations with women through their practice and to make important and timely interventions, for example in interactions around pain relief, or treatments for sleeplessness, fatigue, night sweats or indigestion.

“Where symptoms could point to an undiagnosed condition, pharmacists can play an important role in providing credible information and signposting people for further support and investigation where necessary.”

The Royal Pharmaceutical Society says: “There is a role for community pharmacists to support women post-pregnancy as well as during. All aftercare is normally focused on the baby, but pharmacists could be there to help support the mother. Due to their location, community pharmacies can often support around culturally sensitive issues and potential language barriers.”

References

1. Department of Health & Social Care. Women’s Health Strategy for England (https://assets.publishing.service.gov.uk/government/uploads/system/uploads/attachment_data/file/1100721/Womens-Health-Strategy-England-web-accessible.pdf; accessed January 2023).
2. Pharmacists’ Defence Association, National Association of Women Pharmacists. Response to the Department of Health and Social Care’s call for evidence to inform the Women’s Health Strategy (www.the-pda.org/pda-and-nawp-respond-to-the-department-of-health-and-social-cares-call-for-evidence-on-a-strategy-for-womens-health; accessed January 2023).
3. Royal Pharmaceutical Society Women’s Health Strategy: Call for Evidence: Royal Pharmaceutical Society submission (www.rpharms.com/Portals/0/RPS%20document%20library/Open%20access/Consultations/2021/Women%27s%20Health%20Strategy%20RPS%20submission%20final.pdf?ver=HsxHsbDaXHMmmtXb5_prXg%3D%3D; accessed January 2023).
4. General Pharmaceutical Council. Sodium valproate resources and information (www.pharmacyregulation.org/standards/guidance/sodium-valproate-resources-and-information; accessed January 2023).
5. CCA (Company Chemists’ Association) Response: Department of Health and Social Care Women’s Health Strategy (https://thecca.org.uk/wp-content/uploads/2021/09/CCA-Response-DHSC-Womens-Health-Strategy.pdf; accessed January 2023).